Could two of the most popular foods consumed in the West be a major cause of psychiatric disorders?
Could there be a food-based cure for schizophrenia, bipolar, and depressive disorders? It is my firm conviction that diet – both what it may be deficient in as well as its potential toxicity – can cause what we label as mental illness. In medical school, we learn about the mental repercussions of nutrient deficiencies such as Beriberi (thiamin), Pellagra (niacin), and B12-deficiency induced dementia. We know that minerals such as magnesium and zinc are critical cofactors for basic functions, and that fatty acids are essential in the support of cell membrane health.
I believe in a partnership with my patients; however, my most paternalistic mandate, as a psychiatrist, is that of a gluten and casein free dietary trial.
What’s that? they often ask.
Gluten, from the Latin, “glue” is a composite of proteins comprised of gliadin and glutenin, found in wheat, with similar ‘glutinous’ proteins known as prolamines found in related grains such as rye (secalin), corn (zein), and barley (horedin), and casein is the name for a family of proteins in mammalian milk. How does this relate to the average patient scheduling an appointment with a psychiatrist? Is it possible that our modern, post-industrial foods – sugar, gluten, processed dairy, and genetically modified soy and corn are conspiring with nutrient deficiencies in an incendiary collaboration that will give rise to gut/brain pathology?
If we accept an inflammatory model of mental illness as having the strongest prospects for guiding preventive medicine interventions and non-toxic, reparative treatment approaches, then we must look at underlying drivers of inflammation.
Immune activating and inflammatory proteins, such as those found in wheat and dairy products, may be critical triggers to consider. One of the mostly highly processed foods in our diet – wheat – is almost exclusively rendered as high-glycemic flour, prepared with sugar, and often genetically modified vegetable oils which are oxidized (rancid). Dairy is homogenized and pasteurized, creating a dead, high-sugar liquid with distorted fats, denatured proteins and unabsorbable or thoroughly destroyed vitamins.
Cross-reactivity and stimulation of antibody response by foods like dairy, oats, corn, millet was examined in this study, suggesting that there is important overlap between grains and dairy. Why and how would these foods cause the problems that they do? There are a number of identified reasons for the disturbances caused by America’s darling duo, cheese and bread:
- Fire in the Hole
Lectins in grains and nightshade plants, and proteins in dairy and gluten – namely casein, gliadin and glutenin – can trigger intestinal changes, local, and systemic inflammation. Only recently have we begun to understand how and why. In the case of gluten, zonulin-mediated permeability affords gut contents, including bacterial toxins, access to the bloodstream, where they can play a significant role in driving inflammation and associated psychiatric symptoms, as discussed here.
- Bugging the Bugs
It turns out that diet can be a major determinant of what bugs are most active in our guts, and that the bacteria in our guts may also determine the degree to which we are sensitive to local inflammatory effects of gluten. Gut bacteria are the gatekeepers sounding the alarm by sending inflammatory messages to the rest of the body including the brain.
- Molecular mimicry
When the immune system reacts to a perceived threat such as a food protein, antibodies formed in response may also bind to tissue in glands and organs that share overlapping amino acid sequences. Antibodies can be formed against brain cells, specifically, at times with permanent resultant damage. A study of 400 volunteers found that half of those who reacted to wheat also reacted to brain-based peptides, and the same was found in the subgroup reacting to dairy, suggesting a clustering of reactivity to both brain tissue and these foods.
- The Pleasure of Pizza
Digested proteins from cow dairy and gluten, termed exorphins, interact with opiate receptors in the brain, which accounts for the potentially addictive quality of these foods, and the associated withdrawal when they are taken off the menu.
What does the evidence suggest?
Research into the etiology or cause of syndromes centers around two primary outcomes of interest – associative data that suggests a relationship between an exposure and a cluster of symptoms (% of people with gluten sensitivity who have psychiatric problems), and treatment data that suggests a causative role for that exposure based on the therapeutic effects of its removal (cutting out dairy leads to treatment of depression).
Suspect # 1: Gluten
Assessment of psychiatric pathology in celiac patients has supported a statistically significant incidence of anxiety (panic), depression (21% in this study), bipolar patients, and schizophrenia (27% in this study). When we consider the available evidence base, we have to zoom out to appreciate its inherent limitations – antibody-mediated immune response is just one mechanism by which the body can be alerted to a perceived threat. If you ask to be screened for gluten intolerance, that screening will typically include antibodies to only alpha gliadin, endomesial antibody, and one type of tissue transglutaminase. This testing neglects the role of the innate immune system in non-celiac gluten enteropathy, an inflammatory disorder that often has extra-intestinal manifestations. According to gluten-researcher, Dr. Hadjivassiliou, “gluten sensitivity can be primarily, and at times, exclusively, a neurological disease”.
Since 1953, there have been observations linking schizophrenia and Celiac disease, suggesting that the role of the immune system plays prominently in this poorly understood disorder.
A recent study contributes to the literature suggesting a bidrectional relationship between schizophrenia and autoimmune diseases. In this Danish cohort, individuals with schizophrenia and infectious exposures (hospitalization), the incidence of autoimmune disease was almost 3x as frequent.
The role of antibody complexes feature prominently in the work of Severance et al. who have explored gluten and casein in mental illness, primarily in a cohort of recent onset schizophrenics, non-recent onset schizophrenics, and non-psychiatric controls. In this study, they use complement fixation as an indication of immune reactivity to food/immune complexes that disrupt cellular functioning, demonstrating that those with immune reactions were 4.36 times more likely to be chronic schizophrenics. There is speculation as to the significance of in utero exposure to these foods, and how this may lead to changes to brain modeling, also supported by this study which found a 70% increase in adult schizophrenia in those who had gliadin antibodies at birth.
Even more compelling is the following case presentation:
“a 33-year-old patient, with pre-existing diagnosis of ‘schizophrenic’ disorder, came to our observation for severe diarrhoea and weight loss. A gluten-free diet was started, resulting in a disappearance of psychiatric symptoms, and normalization of histological duodenal findings and of SPECT pattern.”
This means that someone avoided a lifetime of medication with antipsychotics by eliminating gluten from their diet.
In a related report, a case series of three patients treated for depressive syndromes without active intestinal complaints experienced resolution of symptoms on a gluten free diet within 2-3 months, including one patient who was medicated during pregnancy and was able to stop medication within 2 months of dietary change
But I don’t have Celiac!
When I suggest elimination of gluten to patients, they sometimes tell me that they have already been tested, and “don’t have Celiac”. The limitations of currently available conventional testing are very real as most physicians who do a “Celiac panel” are only testing for alpha gliadin, tissue transglutaminase 2, and endomesial antibody, a small portion of the potential immune responses to this food. In a grain consisting of 6 sets of chromosomes, capable of producing greater than 23,000 proteins, this testing may just be too small a window into a very complex space. In one study, inflammatory response was noted in healthy volunteers, suggesting that gluten may cause reactions in everyone.
Suspect # 2 Dairy
The molecular similarity between gluten and casein makes them coconspirators. With quantitatively less literature; however, dairy immune provocation appears to be more variable from person to person. In cow dairy, there are 6 types of protein milk – 4 casein comprising 80% and 2 whey. Within the casein category, A1-beta casein is most commonly present in American cows (Holstein) and is thought to represent a mutated form of the protein, only 5,000 years old. Casomorphin, an opiate-stimulating compound, is released from A1-beta casein. A2-beta casein is found in the milk of sheep, goats, and Jersey cows.
Severence et al. have also identified elevated antibodies to alpha, kappa, and whole casein in new onset and treated schizophrenic patients, stating:
“The elevated IgG and unique patterns of antibody specificity to bovine casein among diagnostic groups provide a rationale for clinical trials to evaluate efficacies of dietary modifications in individuals with neuropsychiatric diseases.”
In patients with casein antibodies, there was a 7-8x increase in the diagnosis of schizophrenia, and they have similarly demonstrated a 3-5x increased risk of Bipolar disorder in patients with casein antibodies (IgG), stating:
“anti-casein IgG associations with bipolar I diagnoses, psychotic symptom history, and mania severity scores suggest that casein-related immune activation may relate to the psychosis and mania components of this mood disorder.”
Beyond direct brain stimulation and poor digestion with local inflammation, cow dairy may also be a source of folate antibodies which can gum up receptors responsible for transporting this critical nutrient to the brain. This study established a linear relationship between these antibodies and exposure to milk – demonstrating resolution of antibodies on a milk-free diet and return with reintroduction of milk.
Gluten and casein free diets have been systematically studied in the autistic population, including in randomized trials; however, no such study design could account for the potential high yield outcomes in any given individual. For this reason, I recommend an empirical trial of at least one month in all individuals struggling with psychiatric symptoms. There are many wonderful and freely available guides to converting to a gluten free life, but the basic principle is to eliminate rye, barley, wheat, and unspecified oats. The difficulty is in identifying the hidden sources of gluten in sauces, condiments, soups, and flavorings. Essentially, going gluten-free should mean eliminating processed food from your life, which is why I have a low threshold to also recommend elimination of co-reactive foods like dairy (casein), corn, soy, and in some cases legumes (including peanuts), and gluten free grains like rice and millet. Dairy elimination would include all milk-based foods and products including yogurt, cheese, and ice cream. Think of these changes as a prescription for brain healing and for bringing your wellness onto a higher plane.
Are you eating a gluten-free diet, but you don’t have celiac disease? A new study suggests that you may not want to make that move. Not only does a gluten-free diet not prevent heart disease, but researchers say avoiding gluten when you don’t have celiac disease could lead to cardiovascular disease and more.
According to the study, people without celiac disease who go gluten-free could wind up with serious health problems, because a gluten-free diet is associated with lower consumption of whole grains, which are associated with a lower risk of heart disease. 
For people with gluten sensitivity – those who don’t have celiac disease, but have abdominal pain and other problems when they eat gluten – it still makes sense to restrict gluten intake.
However, Dr. Andrew T. Chan, an associate professor of medicine at Harvard Medical School in Boston, says:
“It is important to make sure that this [gluten restriction] is balanced with the intake of non-gluten containing whole grains, since these are associated with a lower risk of heart disease.”
Wheat, rye, and barley are all sources of gluten. When people with celiac disease eat foods containing gluten, it triggers an immune reaction that damages the lining of the small intestine. Based on that knowledge, many people who don’t have celiac disease adopt a gluten-free diet, assuming that it is a healthier lifestyle choice.
“The popularity of a low gluten or gluten-free diet in the general population has markedly increased in recent years.
However these findings underscore the potential that people who severely restrict gluten intake may also significantly limit their intake of whole grains, which may actually be associated with adverse cardiovascular outcomes.
The promotion of gluten-free diets among people without celiac disease should not be encouraged.” 
For the study, researchers looked at data from nearly 120,000 health professionals over the age of 26. The participants periodically answered questions over a 26-year period concerning the types of food they ate. Based on participants’ answers, the Harvard team estimated how much gluten each individual consumed in his or her diet.
The researchers also gathered data on whether participants suffered a heart attack during the study, which was considered a proxy for the development of coronary artery disease. 
The scientists, upon dividing the participants in to 5 groups based on the amount of gluten they ate, discovered that those in the group that ate the most gluten were no less likely to have a heart attack than those in the group that ate the least gluten.
At first glance, the data appeared to show that gluten intake was associated with a lower risk of heart attack. But the lower risk wasn’t due to gluten consumption itself. Instead, it was linked with the consumption of whole grains associated with gluten intake.
The team wrote:
“These findings do not support the promotion of a gluten-restricted diet with a goal of reducing coronary heart disease risk.”
The news gets worse. The researchers also found that eating only small amounts of gluten, or not eating it at all, increased the risk of diabetes by 13%. Another “Debbie Downer” finding was that people who ate the least gluten were 15% more likely to suffer from coronary heart disease compared with those who ate the most. 
The researchers concluded that “promotion of gluten-free diets for the purpose of coronary heart disease prevention among asymptomatic people without celiac disease should not be recommended.” 
 The Telegraph
 The Sun
Hi, this is Vani Hari, creator of foodbabe.com.
Everyone from The First Lady Michelle Obama to the American Heart Association (AHA) to several Olympic athletes have endorsed Subway for their purportedly “fresh” and “nutritious” meals.
Unfortunately, not only have these people and organizations been duped, but millions of people across North America have been as well.
I discovered that Subway makes bread with an ingredient called azodicarbonamide. It can be found in almost all the breads at Subway restaurants here in North America, but not in Europe, Australia or other parts of the world.
Azodicarbonamide is the same chemical used to make yoga mats, shoe soles, and other rubbery objects. It’s not supposed to be food or even eaten for that matter. And it’s definitely not “fresh”.
Subway is using this ingredient as a bleaching agent and dough conditioner which allows them to produce bread faster and cheaper without regard to the following health consequences and alarming facts:
- The World Health Organization (1) has linked it to respiratory issues, allergies and asthma.
- When a truck carrying azodicarbonamide overturned on a Chicago highway in 2001, it prompted city officials to issue the highest hazardous materials alert and evacuate people within a half mile radius! Many of the people on the scene complained of burning eyes and skin irritation as a result. (3)
- The U.K. Health And Safety Executive has recognized azodicarbonamide as a potential cause of asthma. (4)
- When azodicarbonamide is heated, there are studies that show it is linked to tumor development and cancer. (5)
- Not only is this ingredient banned in Europe and Australia, but you also get fined 450,000 dollars if you get caught using it in Singapore and can serve 15 years in prison (2).
We deserve the same safer ingredients Subway serves in other countries.
I urge you to join me in asking Subway to remove azodicarbonamide from their products. Subway doesn’t have to reinvent the wheel. They can use the same recipes and ingredients they do across the globe.
Subway is the largest fast food company headquartered in the United States. If Subway changes their Bread, we know this could inspire other food companies across the US to finally eliminate this dangerous chemical once and for all.
North Americans deserve to truly eat fresh – not yoga mats.
- Pandora’s LunchBox by Melanie Warner (pgs. 103 – 104)
Dear CEO Fred DeLuca, Head of Global Marketing Jeff Larson, and Director of Operations Joe Chaves,
Subway azodicarbonamide is a chemical used “in the production of foamed plastics.” It’s used to make sneaker soles and yoga mats.
It’s also used in almost all of your Subway sandwiches, is banned across the globe, and The World Health Organization has linked it to respiratory issues, allergies and asthma. Some studies show that when heated, azodicarbonamide turns into a carcinogen.
We ask you to remove azodicarbonamide from all Subway sandwiches, and make your bread just like you do in other countries. We deserve the same safer food our friends get overseas.
We want to really “eat fresh”, not yoga mat.
For the latest news and media requests, please go to http://foodbabe.com/.
To sign the petition —-> http://foodbabe.com/subway/
UK Daily Mail
April 22, 2011
A chemical which causes cancer has been found in a huge range of foods including bread, crisps and baby food.
Scientists have identified high levels in thousands of cooked and processed products.
The substance, acrylamide, has been linked to several types of cancer including bowel, bladder and kidney, and is known to cause infertility and loss of muscle control.
Scientists have known since 2002 that the chemical exists in certain products and have urged the food industry to reduce levels.
But a major study by the European Union has confirmed that there are still large amounts in a range of items including chips, instant coffee, bread, biscuits, crisps, breakfast cereals and baby food.
Experts are now urging food producers to take stronger action, and are advising the public to cut down on processed food and eat as much fresh produce as possible.
Scientists do not know exactly what causes acrylamide to form but they believe it occurs as a result of a chemical process during baking, frying, grilling or toasting.
It appears to form when food is heated to above 120c. It is not found in uncooked or boiled food.
It is also manufactured for industry and used to make asphalt, glue, dye, paper, fabric and cosmetics as well as to remove impurities in drinking water.
The EUs European Food Safety Authority examined 22 different food groups known to contain high levels of acrylamide in 23 countries, including Britain, and compared levels recorded in 2007 and 2009.
It found despite the warnings, levels had increased in instant coffee and crispbread and remained the same in almost all the other products.
Levels had gone down only in crackers, baby biscuits and gingerbread. The report warns that voluntary measures by the food industry have had €˜limited success and concludes that further action is needed.
It concludes: €˜It would be desirable to reduce acrylamide levels further in food groups contributing the most to exposure, such as fried potatoes including French fries, soft bread, roasted coffee and biscuits.
Experts from the World Health Organisation (WHO) are also urging the public to minimise their risk by cutting down on processed foods, but they say that at the moment there is not enough evidence to justify advising the public to avoid certain foods.
Dr Angelika Tritscher of the WHO said: €˜Acrylamide is clearly carcinogenic. It has been shown to cause cancer in animal studies and we have no reason to think that the same is not true for humans.
€˜We dont know what the risk is and if we tried to quantify it, it would just be a guess which would lead to scaremongering.
€˜But its very important for us to reduce our exposure. It reinforces the importance of a healthy diet.
In 2008 the UK Food Standards Agency found high levels of acrylamide in a range of processed foods including Hula Hoops, Ryvita and Pringles.
The FSA does not currently advise that people should specifically try to avoid foods high in acrylamide.
However, it says that they should seek to cut down on fatty foods such as chips and crisps as part of a balanced diet.